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Textbook of Spinal Surgery: A Comprehensive Guide to the Management of Spinal Problems (2 Volumes)
PS Ramani
VOLUME 1: SECTION 1: BASICS
1:
Historical Evolution of Spinal Surgery
INTRODUCTION
ANCIENT SPINAL SURGERY
Prehistoric and Egyptian Eras
The Greek Period (Hippocratic and Galenic Period) (500 BC to 500 AD)
Celsus (30 BC)
Galen (130–201 BC)
Oribasius (325–400 AD)
Paul of Aegina (625–690 BC)
THE MEDIEVAL PERIOD (500–1500 AD)
Avicenna (980–1037 AD)
Roland of Parma
Guy de Chauliac
The Renaissance (1500–1700 AD)
Ambroise Pare
EARLY SPINAL SURGERY
Victor Horsley
William Macewan
MODERN SPINAL SURGERY
Dr Charles Elsberg
Jean Sicard and Jacques Forester
Junghans J
Mixter and Barr
Henk Verbiest
Paul Randall Harrington
Dr Ralph B Cloward
Dr H A (Alan) Crockard
Dr Arnold Menezes
Prof R Roy Camille
Dr Arthur D Steffee
Dr PM Lin
Dr Manohar Punjabi
John Evans
Fred J Epstein
Dr PS Ramani
Dr Leonard Mallis
Contribution to Spinal Surgery from Japan
INDIAN SPINAL SURGERY
Ancient
Modern Spinal Surgery in India
2:
Applied Anatomy of Spine
INTRODUCTION
The Curvatures of the Spine
The Vertebral Canal
The Bony Lumbar Canal
The Ligamentum Flavum
The Thickness
Content of Elastic Tissue
The Concept of Referred Pain
The Facet Joint
The Facet Joint Syndrome
Pain in the Sacroiliac Joint
The Motion Segment
The Pedicles
THE INTERVERTEBRAL DISC
Parts of the Disc
Functioning Unit
Nutrition
Functional Relationship
THE MUSCLES OF SPINE
The Anterior or Flexor Group
The Paraspinal Muscles
The Abdominal Muscles
MORPHOLOGY OF SEGMENTS OF SPINE
The Cervical Spine
The Thoracic Spine
The Lumbosacral Spine
THE SPINAL CORD
The Sensory Motor Areas of the Spinal Cord
The Blood Supply of Spine and the Spinal Cord
3:
Movements of the Spine
INTRODUCTION
Craniovertebral Junction
The Intervertebral Discs
Regional Amplitude
Axial Rotation
Lateral Bending
The Whole Spine
4:
Biomechanics of the Human Spine: The Effect of Degeneration, Injury and Surgery
OVERVIEW
Function of the Spine
Role of Biomechanics in Spine Surgery
BASIC BIOMECHANICAL PRINCIPLES
Kinematics of Motion
Kinetics or Load-Displacement Behavior
Experimental Approaches
NORMAL SPINAL KINEMATICS
Cervical
Thoracolumbar
EFFECT OF DEGENERATION AND INJURY ON SPINAL KINEMATICS
Degeneration
Injury
Cervical Region
Thoracolumbar Region
EFFECT OF SURGERY ON SPINAL KINEMATICS
Destabilizing Procedures
Cervical: Discectomy
Cervical: Laminectomy/Laminoplasty
Cervical: Foraminotomy/Facetectomy
Thoracolumbar: Discectomy
Thoracolumbar: Facetectomy Foraminotomy
Stabilizing Procedures
Cervical Region
Thoracolumbar Region
CONCLUSIONS
5:
Stability and Instability of the Spine
INTRODUCTION
Stability of the Spine
Horizontal Stability
Craniovertebral Articulation
Other Vertebral Articulations
Rotation and Inclination
The Definition
The Stability
Passive Stabilization
Dynamic Stabilization
Active Stabilization
Hydrodynamic Stability
The Instability
The Instability has Two Basic Elements
Evaluation of Instability
Presentation
Laminectomy and Instability
The Stretch Test
Management
6:
The Origin of Spinal Pain
INTRODUCTION
Sensory Receptors
Early Concepts of Pain
The Nerve Supply
Genesis of Backache
Pressure on Nerves Root
The Gate Control Theory of Pain
Neurotransmitters of Pain
Role of Muscles
Role of Facet Joint
Chemical Factors
The Concept of Referred Pain
The Facet Joint
The Facet Joint Syndrome
Pain in the Sacroiliac Joint
Clinical Observations
Lumbar Fascia
Muscles
Normal Nerve Root
Compressed Nerve Root
Posterior Longitudinal Ligament
Annulus Fibrosus
Vertebral End Plates
Facet Joint
Other Tissues
Conclusions
7:
Neurogenic Claudication
INTRODUCTION
Historical Data
Pathophysiology of Cauda Equina Pain
Symptoms
Pain
Sensory Dysfunction
Motor Function
Sphincter Dysfunction
Signs of Neurogenic Claudication
Spine Percussion Test
Stoop Test
Bicycle Test
Femoral Nerve Traction Test
Straight-Leg Raising Test
Summary
SECTION 2: INVESTIGATIONS
8:
Plain Radiology
9:
Computed Tomographic Evaluation of the Spine
INTRODUCTION
Technique (Fig. 9.1)
Plain CT
Plain and Intravenous Contrast
Plain and Intrathecal Contrast
CT Anatomy of the Spine (Figs 9.2 and 9.3)
Bony Components
Ligaments
Intervertebral Discs
Spinal Canal Contents
PATHOLOGY DEGENERATIVE DISEASES
Degenerative Disc Disease
Lumbar Disc Disease
Cervical Disc Disease
Thoracic Disc Disease
Spinal Canal Stenosis
Lumbar Canal Stenosis
Cervical Canal Stenosis
SPONDYLOLYSIS AND SPONDYLOLISTHESIS
TRAUMA
INFECTION
NEOPLASTIC LESIONS
BMD Measurement
Patients who Cannot Undergo MRI
10:
Myelogram and CT Myelogram
INTRODUCTION
Computerized Myelography (CT Myelography)
Iohexol (Omnipaque)
Technique
Lumbar Myelography
Dorsal Myelography
Cervical Myelography
Cervical Puncture
Extradural Injection
Subdural Injection
IMAGING FEATURES
Extradural Tumors and Masses
Intervertebral Disc Prolapse
Metastasis
Intradural Extramedullary Masses
Leptomeningeal Tumor Spread
Intramedullary Tumors
Hemangioblastoma
Syringomyelia and Other Intramedullary Cysts
Spinal Stenosis
11:
Predictive Value of CT Myelography of Cervical Spine in Degenerative Disorders
INTRODUCTION
The Study
The Material
The Method
The Results
Limitations of CTM
Discussion
Prediction of Recovery by Multiple Regression Analysis
12:
Magnetic Resonance Imaging (MRI) of the Spine
INTRODUCTION
MRI Anatomy of Spine
Intervertebral Disc
Vertebral Body
Spinal Cord
Congenital Anomalies of Spine
Spina Bifida Aperta
Diastematomyelia
Lipomyeloschisis
MISCELLANEOUS SPINAL DYSRAPHISM
Primary Tethered Cord Syndrome
Dorsal Dermal Sinus
Caudal Regression Syndrome
Syringohydromyelia
SPINAL INFECTIONS
Vertebral Osteomyelitis and Discitis
Arachnoiditis
Epidural and Subdural Abscesses
Transverse Myelitis
SPINAL NEOPLASMS
Intramedullary Neoplasms
Gliomas
Ependymoma and Astrocytoma
Hemangioblastoma
Intradural Extramedullary Neoplasms
Neurinoma
Meningiomas
Neurofibromatosis
Extradural Neoplasm
Metastasis
Lymphomas
Arachnoid Cysts
Chordoma and other Primary Neoplasms of Vertebrae
Multiple Myeloma
Hemangioma
SPINAL TRAUMA
Post-traumatic Myelopathy
Acute Myelopathy
MRI Findings
Chronic Post-traumatic Myelopathy
Post-traumatic Syringomyelia
Non-cystic Post-traumatic Myelopathy
Extramedullary Cord Compromise
Fractures
Post-traumatic Disc Herniation
Spinal Epidural Hematoma
MR Appearance
Traumatic Nerve Root Avulsion
MR Appearance
DEGENERATIVE DISEASE OF THE SPINE
Abnormal Intervertebral Disc
Spondylosis and Radiculopathy
Spinal Canal Stenosis
Synovial Cyst
Spondylolysis and Spondylolisthesis
Postoperative Spine
Role of Contrast Agent in Spine
13:
Discography—A Short Review
INTRODUCTION
Definition
Procedure
Indications
14:
Magnetic Resonance Imaging of Spine
INTRODUCTION
MRI Technique
T1-Weighted Images
Proton Density Images
T2-Weighted Images
Gradient Echo Sequences
NORMAL ANATOMY
Appearance of the Vertebrae on MR
Intervertebral Disc
Ligaments and Soft Tissue
Neural Foramina
Dural Sac
Spinal Cord
DEGENERATIVE DISC DISEASE
Disc Aging
Disc Degeneration
Disc Bulges and Herniation
Cervical Radiculopathy
Thoracic Degenerative Disc Disease
Lumbar Degenerative Disc Disease
Stenosis Arthrosis and other Degenerative Disease
Canal Stenosis
Synovial Cysts
Ossification of the Posterior Longitudinal Ligament (OPLL)
Failed Back Syndromes
CONGENITAL SPINAL ANOMALIES
Spina Bifida Aperta
Spina Bifida Occulta
Meningocele
Myelomeningocele
Lipomeningocele
Diastomatomyelia
Syringomyelia
Chiari I Malformation
Chiari II Malformation
Isolated Tethered Cord Syndrome
Dermal Sinus Tracts
Dermoid and Epidermoid
Spinal Lipomas
Filum Terminal Lipoma
INFECTION
Spondylitis and Discitis
Epidural Abscess
Spinal Meningitis Arachnoiditis
Myelitis and Cord Abscess
ROLE OF MR IN SPINAL TRAUMA
Conventional Radiography
Value of MRI
NEOPLASTIC DISEASE OF THE SPINE
Extradural Neoplasms
Chordomas
Hemangiomas
Aneurysmal Bone Cyst
Metastasis
Benign versus Pathological Fractures of the Spine
Extramedullary Intradural Tumors
Meningiomas
Nerve Sheath Tumors
Embryonal Tumors
Metastasis
Intramedullary Tumors
Gliomas
Hemangioblastoma
Metastasis
15:
Electrodiagnosis in Compressive Radiculopathy and Myelopathy
INTRODUCTION
Anatomy of the Cervical and Lumbar Roots in Relation to Electrophysiological Diagnosis
Pathophysiology
Utility of Electrodiagnosis
Electrodiagnostic Tests Routinely Used
Nerve Conduction Studies
H Reflex Recorded from Muscles at Rest
Unmasked H Reflex Contraction Enhanced H Reflex
Needle Electromyography
Changes of Degeneration
Somatosensory Evoked Potentials
Lumbosacral Root Stimulation
Some Important Considerations
Cervical Spondylitic Myelopathy
Summary
SECTION 3: APPLIED NEUROLOGY
16:
Medical Myelopathies
INTRODUCTION
Classification of Medical Myelopathies
Infections
Demyelination
Nutritional Myelopathy
Toxic Myelopathy
Vascular Disease of Spinal Cord
Physical Agents
Hereditary Myelopathies
Tropical Spastic Paraparesis (TSP)
Motor Neuron Disease
Miscellaneous
Infections
Viral Myelitis
Tuberculous Myelitis
Syphilitic Myelitis
HIV Myelopathy
Fungal and Parasitic Infection
Demyelinating Myelopathies
Post-infectious and Post-vaccinal Myelitis
Acute Necrotizing Myelitis
Multiple Sclerosis (MS)
Risk of MS Isolated Myelitis
Devic's Disease (Neuromyelitis Optica)
Nutritional Myelopathy
Vitamin B12 Deficiency
Pellagra
Toxic Myelopathy
Lathyrism
Subacute Myelo-opticoneuropathy (SMON)
Chronic Liver Disease and Portosystemic Shunts
Vascular Disease of Spinal Cord
Cord Infarction (Myelomalacia)
Spinal Cord Hemorrhage (Hematomyelia)
Myelopathy Due to Physical Agents
Radiation Myelopathy
Electrical Injury
Hereditary Myelopathies
Hereditary Spastic Paraplegia (HSP)
Tropical Myeloneuropathies
Tropical Ataxic Neuropathy (TAN)
Tropical Spastic Paraparesis (TSP)
Motor Neuron Disease (MND)
Miscellaneous
Eales' Disease with Myelopathy
Non-metastatic Myelopathy
Conclusion
17:
Peripheral Entrapment Neuropathies
INTRODUCTION
Simple Diagnosis
Confusing Diagnosis
Cause of Neuropathies
Management
Pathophysiology Nerve Entrapment
Common Terminology
Role of Ischemia
Focal Slowing of Conduction
The Syndromes: Clinical Signs and Symptoms
Differential Diagnosis—Radiculopathy
Outline of Treatment
Conclusions
18:
Seronegative Spondyloarthropathies (Synonyms: Seronegative Spondyloarthritis, Seronegative Spondyloarthropathy)
INTRODUCTION
Role of HLA-B27
ANKYLOSING SPONDYLITIS
Criteria for Diagnosis
Epidemiology
Etiology/Pathogenesis
Pathology
Clinical Features
Extra-articular Manifestations
Ankylosing Spondylitis in Females
Juvenile Ankylosing Spondylitis
Laboratory Findings
Radiographic Appearance
Vertebrae
Differential Diagnosis
Treatment
Prognosis
PSORIATIC ARTHRITIS
Clinical Features
Extra-articular Involvement
Laboratory Features
Radiology
Differential Diagnosis
Course and Prognosis
Treatment
REITER'S SYNDROME/REACTIVE ARTHRITIS
Epidemiology
Pathogenesis
Clinical Features
Laboratory Features
Radiological Features
Differential Diagnosis
Treatment
Prognosis
ENTEROPATHIC ARTHROPATHIES
BEHCET'S SYNDROME
SECTION 4: BONE BANKING METHODOLOGY
19:
Ethylene Oxide Gas Sterilized Cadaver Bone Grafts for Spinal Fusion Operations: A Bone Bank
20:
Chloroform-Methanol Treated, Ethylene Oxide Gas Sterilized Bone Allografts: A Bone Bank
INTRODUCTION
Background
Banking Methodology
Donor Selection and Procurement of Bone
Preparation of Chloroform Methanol Treated Ethylene Oxide Gas Sterilized Bone Allografts
Cost of Preparation and Equipments
Biology
Osteoinduction and Osteoconduction
Effects of Chloroform and Methanol on Osteogenetic Properties
Effects of Ethylene Oxide Gas on Osteogenetic Properties
Residual Ethylene Oxide and its By-products
Sterility
Immunological Reactions
Clinical Applications
Guidelines for Clinical Use
The Principles
Lumbar Spine Fusions
Conclusion
SECTION 5: TRAUMA
21:
Spinal Trauma—A Perspective of the Problem
22:
Patterns of Spinal Injuries
INTRODUCTION
On the Site Management
Pattern of Injury to the Cervical Spine
Biomechanics of Injury
Aggrevation of Neurological Damage
Investigations
Management
The Surgery
Mortality and Morbidity
Discussion
23:
Trauma to the Upper Cervical Spine and Craniovertebral Junction
INTRODUCTION
Role of Transverse Ligament
A-O Dislocations
Types of A-O Dislocations
Ligaments at C-V Junction
Stability
Mechanism of Injury
Fractures of Atlas
Fractures of the Odontoid and Axis
Neurological Involvement
MANAGEMENT
Medical Management
Surgical Management
The Stabilization
A-O Injuries
Conclusions
24:
Management of Trauma to the Cervical Spine
INTRODUCTION
Material and Methods
Surgical Procedure
Evaluation
Results
Complications
Discussion
Surgical Timing and Techniques
Selection of the Instruments
Complications
Conclusions
25:
Lower Cervical Spinal Injuries and their Management
INTRODUCTION
Biomechanical Considerations
Mechanism of Injury
TREATMENT
Sprain
Subluxation
Dislocation
Spondyloptosis
Compression Fractures
Anterior and Posterior Stabilization
Anterior Decompression, Stabilization and Fusion
Facet Lock
Corpectomy and Fusion
Operative Complications
Conclusions
CLASSIFICATION OF CERVICAL SPINAL INJURIES
Flexion Injuries
Anterior Dislocation
26:
Thoracolumbar Fractures
INTRODUCTION
Applied Anatomy
Classification of Thoracolumbar Fractures
Wedge Compression Injuries
Burst Fractures
Fracture Dislocations
Flexion Distraction Injuries
Clinical Assessment
Diagnostic Studies
Management
Fracture Dislocations
Flexion Distraction
Complications and Outcome
27:
Classification and Principles of Management of Injuries to the Dorsolumbar Junction
INTRODUCTION
Concept of Spinal Instability
Mechanism
Three Column Theory of Francis Denis
Classification of Thoracolumbar Fractures
Principles of Surgery
Decompression
Stabilizatio
Operative Technique
Complications
Postoperative Mobilization
Conclusions
28:
Harrington Instrumentation in Fractures of Dorsolumbar Spine
INTRODUCTION
Biomechanics of H-Rod System
Spinal Anatomy
Classification
SPINAL STABILITY
Stable Spinal Column
Unstable Spinal Column
Criteria for Optimal Treatment of Spinal Fractures by Instrumentation and Stabilization
Instrumentation Should Achieve Anatomical Reduction and Cause Optimal Correction of the Angular Deformity
Maintain Corrected Spinal Alignment and Recreate Physiological Sagittal Curves
Decompress Spinal Cord and Nerve Roots
Improve Neurological Status
Facilitate Rehabilitation
It Should Lessen Fracture Related Complications
Eliminate Iatrogenic Instrument Related Complications
Conclusions
Disadvantages of H Instrumentation
29:
Treatment of Thoracolumbar Fractures—Combined Approach
INTRODUCTION
Material and Methods
Surgical Technique
Results
Fusion
Discussion
Screw Breakage
Conclusion
30:
Injuries of Lumbar and Sacral Spine
INTRODUCTION
Biomechanics of Lumbar Spine Trauma
Angular Forces
Non Angular Forces
Classification of Fractures
Compression Fractures
Burst Fracture
Flexion-distraction Injuries
Fracture Dislocation
Posterior Arch Fractures
Neurological Evaluation
Pharmacological Treatment
Investigations
Plain LS Spine X-rays
CT Scan
Myelogram
MRI Scan
Instability
Management of Lumbar Spine Injury
Decompression
Stabilization
Luque Rods/Hartshill Rectangle
Fusion
Transpedicular Bone Grafting
Anterior Corpectomy and Fusion
Authors Preferred Method
Role of Nonoperative Treatment
SACRAL FRACTURE
Classification
Mechanism of Injury
Clinical Presentation
Investigations
X-rays
CT Scan
Electromyography
Stability
Management
Zone I
Zone II
Zone III
Complications
SECTION 6: TUBERCULOSIS/SPINAL DEFORMITY
31:
Tuberculosis of the Spine
INTRODUCTION
Pathology
Clinical Features
Investigations
X-ray Features
CT Scan, MRI and Ultrasound
Myelography
Differential Diagnosis
Congenital Defects
Inflammatory Conditions
Tumors
Treatment
Bedrest, Plaster, Traction
Ambulation
Drugs
Surgery
Results of Treatment
Neurological Complications
Treatment of Pott's Paraplegia
Anterolateral Decompression (ALD) of the Cord
Anterior Decompression
Costotransversectomy
Laminectomy
Prognosis for Recovery of Cord Function
Kyphosis
Residual Deformity
Paravertebral Abscess
Radiological Features
Treatment
Sacroiliac Joint
32:
Surgical Correction of Spine Involved in Tuberculosis
INTRODUCTION
Pathological Process
Neurological Involvement
Kyphotic Deformity
Anterolateral Decompression
Ideal Treatment
Modern Surgery
Laminectomy
Prognosis for Recovery
33:
Posterior Stabilization for Kock's Spine
INTRODUCTION
Anatomy and Biomechanics of the Koch's Spine
Evolution of the Surgical Treatment
Complications of the Graft
Unfavorable Outcome from Anterior Surgery
Tuberculous Spine with Kyphotic Deformity
Long Defect
Thoracolumbar Junctional Lesions
Children
Functions of Posterior Instrumentation
Correction of Deformity
Immobilisation of the Anterior Construct
Offloading of the Graft
Prevention of the Deformity
Early Rehabilitation
Posterior Fusion
Surgical Procedure
Results
Discussion
Conclusions
34:
Management of Severe Kyphotic Deformity in Tuberculosis of the Spine
INTRODUCTION
Evolution of Severely Kyphotic Deformity
Prevention of Severe Deformity
Correction of Severe Kyphotic Deformity
Neurological Complications due to Severe Kyphotic Deformity
35:
Evaluation and Management of Spinal Deformities
NORMAL CURVATURES OF THE SPINE
Spinal Deformities
Justification for Treatment of Spinal Deformities
SCOLIOSIS
History (The Past)
Nonstructural Scoliosis
Terminology
PATIENT EVALUATION
History
Spine Deformity
Physical Examination
School Screening
Radiographic Evaluation
Routine Radiography
Radiation Hazards
Special Imaging Studies
MANAGEMENT
Orthosis
Role of Traction in Scoliosis
Cast Techniques
Techniques of Surgery
Facet Joint Fusions
Posterior Spinal Instrumentation
Anterior Approach
The Growth Factor
Authors Experience
Scoliosis; 24 cases
Miscellaneous Scoliosis: 3 Cases: (Neurofibroma Polio)
Recent Advances
THORACIC AND THORACOLUMBAR KYPHOSIS
Classification
Neuromuscular
Late-Paralytic; Congenital-at Birth
Metabolic
Skeletal Dysplasias
Collagen Disorders
Pathological Vertebral Fractures
Authors Classification Depending on the Plan for Correction
Angular Kyphosis (Group 1)
Patient Evaluation
History
Physical Examination
Radiology
Special Imaging
Principles of Management
Authors Experience
Observations and Recommendations
SECTION 7: TUMORS
36:
The Principles of Management of Spinal Tumors
INTRODUCTION
Incidence and Nature of Lesions
Clinical Presentation
Investigations
Surgical Staging System
Management
Oncological Considerations
Surgical Considerations
Cervical Region
Dorsal Region
Lumbar Region
Other Considerations
Stabilization
To Sum Up
Sacrum
Clinical Presentation
Treatment Consists of
Problems and Difficulties
Conclusions
37:
Intraspinal Tumors
INTRODUCTION
Incidence and Classification
Adult Tumors
Benign Tumors
Malignant Tumors
Other Tumors that Occur much less Frequently
Intradural Tumors
Pediatric Tumors
Presentation
Clinical Presentation
Pain
Sensory Changes
Bladder Changes
Specific Lesions
Investigations
Plain X-ray
Myelogram
CT and MRI Scan
Neurophysiologic Studies
Management
With Warts and all (Oliver Cromwell)
Surgical Management
Aids to Surgery
Anesthesia
Role of Intraoperative Imaging (Image-intensifier and Ultrasound)
A Fool with a Tool is Still a Fool (Lars Leksell)
Microsurgical Techniques (Microscope, Bipolar Cautery, Microsurgical Instruments)
Ultrasonic Surgical Aspirator and Laser
Frozen Section Histopathology
Intraoperative Neurophysiological Monitoring
Operative Techniques
Postoperative Care and Complications
CSF Leaks
Spinal Instability
Radiotherapy
Ancillary Treatment
Results of Treatment
Conclusion
38:
Vascular Malformation of the Spinal Cord
INTRODUCTION
History
Blood Supply of the Spinal Cord
Classification of Spinal Vascular Malformation
Clinical Presentation of Spinal Vascular Malformations
Investigations (Table 38.2)
Plain Radiographs
Myelography
MRI with MR Angiography
Spinal Angiography
Differential Diagnosis
Embolization
Surgery
Dural AVF
Juvenile AVM
Glomus AVM
Intradural AVF
SECTION 8: CERVICAL SPONDYLOSIS
39:
Pathogenesis and Pathology of Cervical Spondylosis
INTRODUCTION
Pathology
Bony Cervical Canal
Magnetic Resonance Imaging
Pathology
The Intervertebral Disc
Uncovertebral Joints
Apophyseal Joints
Vertebral Artery
Grading of Cervical Spondylotic Myelopathy
Cervical Spondylotic Changes in the Aged
Factors Responsible for Myelopathy in Cervical Spondylosis
40:
Clinical Features of Cervical Spondylosis
SYMPTOMS
Examination
1. Radiculopathy
2. Myelopathy
3. Neck Pain
4. Headache
5. Vertebrobasilar Insufficiency
41:
Level Diagnostic Neurology of Cervical Spondylotic Myelopathy
INTRODUCTION
Identification of Dermatome Areas
Relationship Between the Level of Discal Compression and Signs of Myelopathy
Mechanisms Underlying the Occurrence and Distribution of Numbness
Discrepancy Between Signs and Symptoms Following One Level Discal Spinal Cord Compression
Clumsiness of the Fingers
42:
Principles of Management of Cervical Spondylosis
INTRODUCTION
Rest to the Part
Collar
Cervical Traction
The Role of Firm Mattress and Pillow
The Role of Conservative Treatment
Surgical Treatment
Salient Features of Surgical Technique
Postoperative Period
43:
The Surgical Technique of Anterior Approach to the Cervical Spine and Interbody Fusion
INTRODUCTION
Reasons for Developing Anterior Approach
Complete Surgical Decompression
Anesthesia and Position
Muscle Dissection
Disc Removal
Vertebral Trephine (Drill Hole)
Nerve Root and Spinal Cord Decompression
Removal of Bone Graft
Interbody Fusion
Wound Closure
Postoperative Care
44:
The Surgical Technique of Anterior Approach to the Cervical Spine and Interbody Fusion. Modification of Smith and Robinson Technique
INTRODUCTION
Cloward's Anterior Approach to Spine
Advantages of Smith and Robinson's Technique
Anesthesia and Position
Dissection of Muscles
The Blood Vessels
The Retractors
Removal of Disc
Partial Decortication
Key Stone Effect
The Bone Graft
The Fusion
Wound Closure
Postoperative Care
45:
Role of Decompressive Laminectomy in the Surgical Management of Cervical Spondylosis
INTRODUCTION
Basic Pathology
Pitfalls of Laminectomy
Anterior Cervical Approach
Results
Analysis
Conclusion
A Word About Cervical Laminoplasty
46:
Treatment of Multilevel Cervical Spondylosis
INTRODUCTION
Clinical Presentation
Treatment Options
Results
47:
Cervical Spondylotic Myelopathy
INTRODUCTION
Bony Cervical Canal
Neurodiagnostic Techniques
Magnetic Resonance Imaging
Grading of Cervical Spondylotic Myelopathy
Cervical Spondylotic Changes in the Aged
Factors Responsible for Myelopathy in Cervical Spondylosis
Clinical Presentation
Treatment (Rationale of Surgical Approach and Prognosis)
Against Laminectomy45
Bone Graft
Operative Technique
Discussion
48:
Expansive Open-door Laminoplasty for Cervical Spinal Stenotic Myelopathy
INTRODUCTION
Operative Procedure
Results
Complications
Conclusion
49:
Myelopathy due to Ossification of the Spinal Ligaments OPLL and OYL
INTRODUCTION
CERVICAL OPLL
History and Etiology
Pathogenesis of OPLL
Pathology
Roentogenographic Examination
Symptoms and Signs
Treatment
THORACIC OPLL
OYL
50:
Laminoplasty
VASCULARIZED PEDICLE LAMINOPLASTY
Technique
Discussion
Evolution of Bone Flaps
Ease of Technique
THORACIC LAMINOPLASTY USING SPINOUS PROCESSES
Technique
Discussion
51:
Central Corpectomy for Cervical Spondylotic Myelopathy
INTRODUCTION
Justification for Central Corpectomy
Corpectomy and OPLL
Anterior Versus Posterior Approach
Indications
The Surgery
Material and Methods
Diagnosis
Preoperative Symptoms
OPERATIVE TECHNIQUE
Position of Patient
Incision and Exposure
Decompression
Fusion
Bone Graft
Vascularized Fibular Grafts
Results
Our Series
Complications
VULNERABILITY OF C5 ROOT
C5 Radiculopathy
Graft Displacement
Dysphagia and Hoarseness
Infection
Discussion
Long Follow-up
SERIES REVIEW
Conclusions
SECTION 9: PROLAPSED LUMBAR INTERVERTEBRAL DISC
52:
Lumbar Intervertebral Disc Prolapse
HISTORICAL BACKGROUND
APPLIED ANATOMY OF LUMBAR SPINE
The Vertebra
The Intervertebral Disc
Parts of the Disc
Functioning Unit
Functional Relationship
The Muscles
The Bony Lumbar Canal
The Ligamentum Flavum
The Facet Joint
The Facet Joint Syndrome
Pain in the Sacroiliac Joint
The Motion Segment
Normal Movements of the Lumbar Spine
Biomechanics of Lumbar Spine The Disc
Motion Segment
Load Bearing
Degeneration
Abnormal Motion
NATURAL HISTORY OF DEGENERATIVE CHANGES IN LUMBAR SPINE
Introduction
CHANGES THAT OCCUR WITH AGE
The Bone of the Vertebra
The End Plates
The Disc
Degenerative Changes
Phases of Degeneration
Degeneration in the Disc
Disc Prolapse
Irreversible Change
Role of Trauma
Neural Involvement in Disc Prolapse
FAR OUT LATERAL (EXTRAFORAMINAL DISC PROTRUSION CAUSING ROOT COMPRESSION)
DISC PROTRUSION IN THE YOUNG
FREQUENCY OF DISC PROLAPSE
CAUSES OF BACKACHE
Introduction
Unusual Activity
Life in the City
Occupational Backache
Poor Posture
Occupational Poor Posture
Overweight
Muscle Sprain
Prolapsed Lumbar Intervertebral Disc
The Facet Joints
Spinal Stenosis
Less Common Causes
Differential Diagnosis
Is Backache Different for Different People?
CAN BACKACHE BE PREDICTED?
Computerized Isokinetic Testing (CIT)
ERGONOMICS
BACKACHE DUE TO SACROILIAC JOINT PAIN
Ankylosing Spondylitis
CARDINAL SYMPTOMS OF THE PATIENT
Low Back Pain
Sciatic Pain
NEUROGENIC CLAUDICATION
Blood Supply
Back Pain
Sensory Dysfunction
Sciatic Pain
CLINICAL PRESENTATION OF THE PATIENT
Precipating Factor
The Low Back Pain (LBP)
The Sciatica
Paraesthesiae
Muscle Weakness
Disturbance of Sphincters
The Cauda Equina Syndrome
Intermittent Neurogenic Claudication
The Syndrome of Facet Hypertrophy and Tropism
PHYSICAL SIGNS
Stance and Gait
Involvement of the Muscles
Sensations
Reflexes
Tension Signs
Straight Leg Raising
Femoral Stretch Test
A TYPICAL PRESENTATION OF 4th LUMBAR DISC PROLAPSE
A TYPICAL PRESENTATION OF 5th LUMBAR DISC PROLAPSE
INVESTIGATIONS PLAIN X-RAYS OF THE LUMBAR SPINE
Sacralization
Oblique Views
MYELOGRAPHY
Cerebrospinal Fluid
DISCOGRAPHY
The Procedure
CT SCANNING OF THE LUMBAR SPINE FOR DISC PROLAPSE
Contrast Enhanced CT Scanning of the Spine
MAGNETIC RESONANCE IMAGING OF THE LUMBAR SPINE
DIFFERENTIAL DIAGNOSIS
RADIOLOGY IN SPINAL STENOSIS
MEASUREMENTS
RADIOLOGY IN SPONDYLOLYSIS/SPONDYLOLISTHESIS
Associated Findings
THE TREATMENT CONSERVATIVE MANAGEMENT
Once a Backache Always a Backache
Bedrest
Fomentation Ice or Heat
Massage
Drugs
Traction
Braces and Corsets
Manipulation
Epidural Block
Exercises
THE SURGICAL TREATMENT
Indications for Surgery
Principles of Surgery
The Laminectomy
Hemilaminectomy
The Fenestration
The Position
Exposure of the Disc
Excision of the Disc
The Discoplasty
Nerve Stimulation
Closure
Postoperative Care
LAMINECTOMY PATCH
WOUND INFECTION
Guidelines
Removal of Implants
Period of Antibiotic Regime
Role of PLIF in Disc Surgery
POSTOPERATIVE MOBILIZATIONOF THE PATIENT
Introduction
THE PAST
Principle of Postoperative Rest
Necessity of Getting Up Early Out of Bed
Sports Medicine Approach
The Use of Belt
EXERCISES AFTER SURGERY ON THE BACK
Passive Exercises
Functional Exercises
Active Exercises
Resistive Exercises
Flexion and Extension Exercises
More Active Exercises
THE PROTOCOL
RESULTS AND PROGNOSIS
Introduction
Sciatica
Backache
Neurological Deficit
53:
Microdiscectomy for Lumbar Disc Herniation
INTRODUCTION
1. Preoperative Diagnostic Imaging
2. Surgical Procedure
3. Operative Results
4. Problem of Microdiscectomy
54:
Microlumbar Discectomy
INTRODUCTION
Material and Methods
Criteria for Selection
Following Criteria were Used to Select the Patients
Division of Cases (Based on Criteria for Selection)
Group I Backache and Sciatica
Group II (More Common Group) Compression of S1 Root
Group III (Common Group) Compression of L5 Root
Group IV (Least Common) Compression of L4 Root
Group V Compression of Two Roots
Pattern of Cases Selected for Microlumbar Discectomy
Radiology
OPERATIVE TECHNIQUE
The Surgical Microscope
Position
Skin Incision
Superficial Exposure
Exposure of Inerlaminar Space
Excision of Ligamentum Flavum
Exploration of Epidural Space
Retraction of Nerve Root
Incision of Post Long Lig
Closure
Postoperative Management
Complications
Resumption of Duties
Results and Discussion
Recurrence
Conclusions
VOLUME 2: SECTION 10: MINIMALLY INVASIVE PROCEDURES
55:
Chemonucleolysis—A Review
INTRODUCTION
Chymopapain
Mechanism of Action
Adverse Effects
Indications
Contraindications
Absolute
Relative
Hypersensitivity Test
Injection Technique
Postprocedure Care
Complications
1. Anaphylaxis
2. Subarachnoid Injection
3. Root Damage
4. Discitis
Prognosis
Chemonucleolysis Outlawed
Other Agents
56:
Automated Percutaneous Lumbar Discectomy (APLD)
INTRODUCTION
Clinical Evaluation
SURGICAL TECHNIQUE
Position of Patient
The Technique
Extent of Excision
Postoperative
Advantages
Return to Work
Discussion
57:
Minimally Invasive Technique for Lumbar Disc Herniation
INTRODUCTION
History
Patient Selection
Position of Patient
Determining the Entry Point
Anesthesia
Placement of Nucleotome
Results
Discussion
58:
Laser Assisted Percutaneous and Endoscopic Lumbar Discectomy
INTRODUCTION
The Laser System
Basic Principle
Principles of Surgery
Material and Methods
Investigations
Viviprudence
Principles of Laser Surgery
Treatment Options
Percutaneous Laser Discectomy
KTP 532 Laser Discectomy
Holmium Laser Discectomy
Double Pulse Holmium Laser Discectomy
Results
Advantages of Laser Discectomy
Posterior Wall Reconstruction
Flexible Endoscopic Intradiscal Discectomy (FEID)
Endoscopic Laser Foraminoplasty (ELF)
Endoscopic Intradiscal Fusion (EIF)
Bionucleoplasty-Endoscopic Disc Reconstruction (EDR)
Endoscopic Epiduroplasty (EE)
Myeloscopy
Endoscopic Facet Joint Surgery (EFJS)
Minimal Intervention Fenestrectomy (MIF)
THE LASER TECHNIQUES
Preparation of Patient
Laser Decompression of Disc
Endoscopic Discectomy
Postoperative Course
Complications
Immediate Flare
Early Flare
Late Flares
Contralateral Flare
Return to Original Job
Conclusions
SECTION 11: DEVELOPMENTAL ANOMALIES
59:
Bony Anomalies of the Craniovertebral Junction
INTRODUCTION
Development of the Craniovertebral Junction
Anatomy of the Joints of the Craniovertebral Junction
Classification of Craniovertebral Junction Anomalies
Clinical Presentation
Investigations
Diagnostic Criteria
Management
I. Fusion Procedures
A. Atlantoaxial Fusion
B. Occipitocervical fusion
II. Decompression Procedures
1. Transoral Transpharyngeal Odontoidectomy
2. Posterior Decompression
Combined Anomalies
Special Problems Related to Managing Patients with CVJ Anomalies in India
Outcome
60:
Combined Anterior Transoral Decompression and Posterior Stabilization with Occipital Hartshill Ring for Atlantoaxial Dislocation
INTRODUCTION
Material
Preoperative Assessment
Anesthesia
Intubation
Surgical Technique
Special Precautions
Posterior Occipitocervical Contoured Hartshill Ring Fixation
The Technique
Postoperative Period
Complications
Outcome
Conclusions
61:
Surgical Approaches to the Craniovertebral Junction—A Review and Posterior Occipitocervical Fixation
INTRODUCTION
Management of Craniovertebral Junction Pathology
Neurodiagnostic Procedures
Decision-making and Extent of Exposures
Conclusions
Posterior Occipitocervical Fixation
Indications for Occipitocervical Fusion
Types of Occipitocervical Arthrodesis
OPERATIVE TREATMENT
Preoperative Evaluation
Operative Technique of Occipitocervical Fusion
Dorsal Occipitocervical Interlaminar Cervical Fusion with Bone
Occipitocervical Interfacet Fusion
Methyl Methacrylate Supplement
Contoured Loop Instrumentation
Postoperative Care
Results
62:
Spinal Dysraphism
INTRODUCTION
History
Normal Embryology (Table 62.2)
(a) Neurulation
Pathogenesis of Neurulation Defects—in Experimental and Human Studies
Postneurulation Development of Neural Tube
Terminology
Incidence
Genetics, Etiology and other Factors
Maternal Age and Parity
Socioeconomic Condition
Nutritional Deficiency
Pathology
Spinal Cord
Pathology in Brain
Cutaneous and Skeletal Abnormalities
Other Systemic Pathologies Associated with Spinal Dysraphism (Table 62.3)
Clinical Presentations
Diagnosis
Radiology
Special Imaging
Electrophysiology
Treatment
Meningomyelocele and Meningocele
Surgical Technique
Problems of Skin Closures
Postoperative Care and Complications
Results and Overall Outcome
Other Forms of Spinal Dysraphism Lipomyelomeningocele
Pathology
Surgery for Lumbosacral Lipoma
Occult Spinal Dysraphism
Pathology
Split Cord Malformation (SCM)
Location
Pathogenesis
Clinical Features
Investigations
Treatment
Conclusions
63:
Syringomyelia
INTRODUCTION AND TERMINOLOGY
Historical Review
Pathogenesis of Syringomyelia Associated with Hindbrain Anomalies
Clinical Manifestations of Syringomyelia
Post-traumatic Syringomyelia
Diagnostic Investigation
Management
Complications and Prognosis
SECTION 12: LUMBAR FUSION AND STABILIZATION
64:
Philosophy of Posterior Lumbar Interbody Fusion
INTRODUCTION
Advantages of PLIF
Clinical Indications
Biomechanical Principles of PLIF
Motion Segment
Tropism
Smith-Robinson Principle of Interbody Fusion
Stabilization and PLIF
Stages of Osteosynthesis in PLIF
65:
Indications for Posterior Lumbar Interbody Fusion
INTRODUCTION
Basic Principles
Why PLIF
Clinical Conditions where the PLIF Can be of Value
Ruptured and Prolapsed Lumbar Intervertebral Disc
Lumbar Spondylosis
Following Changes have been Observed in Spondylosis
Spinal Stenosis
A. Spinal Canal Stenosis
B. Foraminal Stenosis
C. Scar Stenosis
The Failed Back
A. Failed Disc Operations
B. Laminectomy
C. Dorsal Arch Resection
D. Posterior and Posterolateral Spinal Fusions
E. Wrong Level
Lateral Rescess Nerve Root Entrapment
Chronic Backache
Spondylolisthesis and Spondylolysis
66:
A Model for Posterior Lumbar Interbody Fusion
INTRODUCTION
Placement of Grafts Under Impaction
Graft Objectives
PLIF Constructs
Author's Construct
Bank Bone
Live Bone
The Construct
Postoperative period
Results
Settlement
Discussion
Conclusions
67:
Posterior Lumbar Interbody Fusion (PLIF) The Operative Technique
INTRODUCTION
Why Posterior Lumbar Interbody Fusion?
Operative Technique
Position and Anesthesia
Skin Incision
Fascia and Muscles
Ligamentum Flavum and Laminae
Disc Removal
Bone Grafts
Bone Grafting
Wound Closure
Postoperative Care
Discussion
Transverse Skin Incision
Ligamentum Flavum
Use of Chisel and Hammer
Articular Facets
Disc Removal
Postoperative Cortisone
68:
Posterior Lumbar Interbody Fusion Using the Threaded Fusion Cage
INTRODUCTION
Surgical Technique
Clinical Material
Results
Complications
Conclusion
69:
Anterior Lumbar Interbody Fusion (ALIF)—A Review
INTRODUCTION
Historical Background
Indications
Basic Requirements
Preparation of the Patient
Position of the Patient
Incision
Incision of Muscles
Separation of Peritoneum
Applied Anatomy
Intraoperative Difficulties
Excision of the Disc
Choice of Grafts
Postoperative Immobilization of the Patient
Complications
Results
Summary
70:
Anterior Lumbar Vertebral Interbody Fusion
INTRODUCTION
Preparations for Surgery
Positioning Patient on the Table
Incision
Approaches to the Lower Lumbar Disc Spaces
Approaches to the Upper Lumbar Disc Spaces
Fusion at the Lumbosacral Level
Preparation of the Dowel Cavities
Preparation of the Grafts
Insertion of the Grafts
Closure
Fusion at the L4/5 Interspace
Fusion at the L3/4 Interspace
Fusion of the Upper Lumbar Discs
Postoperative Care
Conclusion
SECTION 13: SPONDYLOLISTHESIS
71:
Spondylolisthesis—A Review
DEFINITION
History
Classification
Congenital or Dysplastic
Isthmic
Degenerative
Traumatic
Pathological
Post-surgical
Incidence and Etiology
Inheritance Factor in Type I and Type II
Natural History
1. Congenital
Type IA: Dysplastic
Type IB: Sagittal Orientation
2. Isthmic
3. Degenerative
Symptoms
Pain Types
A. In Children
B. In Adults
Physical Findings
Radiographic Terminology and Measurements Meyerding's Classification (1932)
Plain X-rays
Management in Adults
Indication for Surgery6,7
Goals of Surgery
Surgical Options: Pars Defect Repair
Traumatic Lysis
Management of Spondylolisthesis (Grade I and II)
In Situ Fusion
Decompression
Anterior Interbody Fusion
Reduction and Fixation
Risk Factors
Current Reduction Techniques
Posterior Grafting and Extension Casting (Bradford)
Posterior Instrumented Reduction
Posterior Instrumentation
Reduction
Type III (Degenerative Spondylolisthesis)
Surgical Treatment
For Severe Listhesis Grade III and IV
The Cascading Spine
Spondyloptosis
Results
Authors Preferred Treatment
Listhesis Grade I and II Without Neuro Symptoms
72:
Management of Spondylolisthesis
INTRODUCTION
Stability Achieved by Posterolateral Fusion
Surgical Correction of Spondylolisthesis
Posterior Lumbar Interbody Fusion (PLIF)
Technique of Reduction of Spondylolisthesis
Correction of High Grade Spondylolisthesis
Discussion
73:
Surgical Treatment of Spondylolysis and Spondylolisthesis
INTRODUCTION
Spondylolysis
Spondylolisthesis
Three - One Method6
1. Technique for Obtaining the Bicortical Bone Plugs
2. To Remove the Posterior Neural Arch
3. Reduction of Vertebral Slippage and PLIF
4. Repositioning of Posterior Neural Arch
5. VSP Fixation
6. Bone Chip Fusion into Interarticular Defect
7. Wiring Posterior Neural Arch
Intact Pars Isthmic Spondylolisthesis
Discussion and Conclusion
74:
Posterior Lumbar Interbody Fusion for Degenerative Spondylolisthesis
INTRODUCTION
Materials and Methods
Symptoms Before Surgery
PLIF Surgery
Reinforcement Procedures
Clinical Evaluation
Roentgenological Evaluation
Classification of Fusion Results
Union in situ
Delayed Union
Collapsed Union
Nonunion
Comparative Studies
Fusion Results
Clinical Outcome
Discussion and Conclusions
75:
Surgical Reduction of Spondylolisthesis with the Schollner and the CD Instrumentation
INTRODUCTION
Indications
Management
Technique
Alternate Instrumentation
Preliminary Results
Complications
Discussion
SECTION 14: SPINAL STENOSIS/ANKYLOSING SPONDYLITIS/SACRUM
76:
Spinal Stenosis—Its Recognition and Management by Internal Decompression for Spinal Stenosis (IDSS)
INTRODUCTION
Historical Background
Anatomical Considerations
Pathogenesis
Transient Dysfunction
Instability
Fixed Deformity
Two Nerves at Risk
Clinical Presentation
Radiology
Operative Technique
Incision and Exposure of Spine
Decompression
Stabilization
Closure and Postoperative Care
Results
Discussion
77:
Surgery in Ankylosing Spondylitis
INTRODUCTION
Incidence
Radiology
Surgical Correction
Case Reports
Case No. 1
Case No. 2
Case No. 3
Case No. 4
Case No. 5
Discussion
Risks of Surgery
Conclusions
78:
Surgical Disorders of Sacrum
INTRODUCTION
Embryology
Surgical Anatomy
Biomechanics and Weight Transmission
Spina Bifida Occulta
Posterior Sacral Meningoceles and Myelomeningoceles
Surgical Management
Lipoma and Lipomyelomeningocele
Treatment
Tethered Cord Syndrome
Clinical Features
Radiologic Evaluation
Treatment
Anterior Sacral Meningoceles
Clinical Features
Radiographic Evaluation
Treatment
Sacral Fractures
Sacral Osteomyelitis
Osteomyelitis of the Sacrum
Pyogenic Sacroilitis
Tuberculous Infection of the Sacroiliac Joint
Sacrococcygeal Chordoma
Pathology
Clinical Features
Radiographic Evaluation
Treatment
Sacrococcygeal Teratoma
Diagnosis
Treatment
Prognosis
Primary Tumors of the Sacrum
Benign Tumors
Giant Cell Tumor
Aneurysmal Bone Cyst
Malignant Tumors
SURGICAL APPROACHES TO THE SACRUM
Posterior Transsacral Approach
Anterior Approach
Perineal Approach
Lateral Approach
Combined Approaches
Sacrectomy
SECTION 15: SPINAL INSTRUMENTATION
79:
Posterior Fusion of the Atlas and the Axis by Transarticular Screw Fixation (Magerl Technique)
INTRODUCTION
Surgical Technique
Results
Discussion
80:
Transarticular Screw Fixation (Magerl's Technique) for Traumatic Atlantoaxial Instability
INTRODUCTION
Clinical Cases
Case 1
Case 2
Case 3
Conclusions
81:
Lateral Mass Plate and Screws Fixation for Atlantoaxial Subluxation
INTRODUCTION
Clinical Features
Investigations
Treatment
Atlantoaxial Dislocation (AAD)
Clinical Presentation
Investigation
Reduction of Dislocation
Fixed Atlas
Surgical Considerations in Atlantoaxial Dislocation
Ideal Method of Fusion
Lateral Mass Plate and Screw Fixation for Atlantoaxial Subluxation
Operative Technique
Discussion
Reversal Foramen Magnotomy and Lateral Mass Fixation for Chiari Malformation Associated with Atlantoaxial Dislocation
Operative Technique of Foramen Magnotomy
82:
Internal Fixation of Cervical Spine with Hartshill Rectangle
INTRODUCTION
Hartshill Rectangle
The Wires
Indication
Technique
Preparation for Passage of Wires
Selection of Rectangle
Passage of Wire
Insertion of Rectangle
Postoperative Management
Special Circumstances
Results
Complications
Assessment of Fusion
Discussion
83:
Posterior Spinal Fusion of the Cervical Spine Using Alligator Plate
INTRODUCTION
The Alligator Plate
Operative Technique
Results
84:
Posterior Cervical Stabilization with Lateral Mass Plate Technique
INTRODUCTION
General Information
Technique
Note
Plate Selection
Note
Technical Recommendations
85:
The Variable Screw Placement System
INTRODUCTION
The VSP System
TECHNIQUE
Materials
Patient Position and Incision
Transpedicular Screws in the Lumbar Spine
Screws at S1
Posterior Lumbar Interbody Fusion
Wound Closure
Observations and Advice
Complications
86:
Graf Ligaments
BIOMECHANICS
Therapeutic Proposal
Material and Methods
The Implant
The Ligament Prosthesis
Biomechanical Properties of the Prosthesis and its use
Indications for Use
Iatrogenic Pathology
Lumbar Stenosis
Spondylolisthesis
Degenerative Disc Disorder
RESULTS
Pain and Level of Function
Radiographic Results
Complications
Discussion
Conclusion
87:
Fixation of Lumbar Spine with Pedicle Screws and Plates
INTRODUCTION
Anatomy of the Lumbar Pedicle
Relations of the Pedicle
Screws and Plates
Surgical Technique
Lumbosacral Surgery
Lumbosacral Fusion for Degenerated Disc
Reduction and Fixation of High-grade Spondylolisthesis
Malunion
Discussion
88:
Cervical Stabilization with Halo Vest Apparatus
INTRODUCTION
Methods
Results
Discussion
SECTION 16: SURGERY AROUND CRANIOVERTEBRAL JUNCTION
89:
One Stage Transoral Decompression and Posterior Fixation in Rheumatoid Atlantoaxial Subluxation
90:
Extreme Lateral Transcondylar and Transjugular Approaches
INTRODUCTION
Preoperative Evaluation
Operative Technique
Anesthesia
Operative Procedure
Stability
Postoperative Care
Results
Extent of Tumor Resection
Posterior Fossa Lesions
Spinal Lesions
Complications
Posterior Fossa Lesions
Spinal Lesions
A Illustrative Case
Transcondylar and Transjugular Approaches
Discussion
91:
Far Out Lateral Transcondylar Approach for Anterior Craniovertebral Junction Meningioma
INTRODUCTION
92:
Extreme Lateral Approach for Radical Removal of Large Clivus Chordoma and Bone Graft to the Craniovertebral Joint
INTRODUCTION
The Operation
Case Reports
Case I
Case II
Discussion
93:
Posterior Far Lateral Transcondylar Approach to Anterior Craniocervical Junction Tumor
94:
Transcervical Approach to the Anterior Craniovertebral Junction
INTRODUCTION
Material and Methods
The Procedure
Postoperative Management
Discussion
95:
Approach to Anterior Craniovertebral Junction and Skull-base Tumors Extended Maxillotomy (Le Fort Osteotomy)
INTRODUCTION
Investigations
Position of Patient
Anesthesia
Surgical Technique
Maxillotomy
Nasal Cavity
Surgical Reconstruction
An Illustrative Case
Postoperative Care
Postoperative Complications
Conclusions
Surgical Reconstruction
Postoperative Care
Postoperative Complications
Conclusion
SECTION 17: SURGERY ON DORSAL SPINE
96:
Surgical Fixation of the Cervicothoracic Junction: Posterior or Anterior Approach?
INTRODUCTION
Material and Methods
Surgical Technique
Results
Clinical Results
Radiographic Results (Tables 96.1 and 96.2)
Complications
Discussion
The Cervicothoracic Region is Well-known for its Difficulty to Explore
Analysis in the Sagittal Plane
Analysis in the Frontal Plane
This Region is Well-known for its Difficulty of Approach
The Posterior Approach
Secondary Displacements
Conclusion
The Tumors
97:
Transclavicular Approach to Anterior Upper Dorsal Spine (D1 to D4)
INTRODUCTION
Operative Technique
Anesthesia and Position
Technique
Postoperative Care
Results
The Levels Affected
Complications
Discussion
98:
Video-assisted Thoracoscopic Spine Surgery
INTRODUCTION
Historical Review
Thoracoscopy
Spinal Thoracoscopy
Indications and Contraindications
Indications
Contraindications
Absolute Contraindications
Relative Contraindications
Preoperative Evaluation
Radiological Evaluation
Anesthetic Evaluation
Pulmonary Assessment
Cardiac Assessment
Risk Evaluation
Surgical Anatomy
The Bony Anatomy
The Thoracic Vertebrae
The Vertebral Arch
The Rib
The Costo-vertebral Articulations
The Articulation of the Head of the Rib
The Costotransverse Articulation
The Soft Tissue Covering: The Costovertebral Pleura
The Arteries: The Posterior Intercostal Arteries
The Veins: The Posterior Intercostal Vein
The Nerves
The Thoracic Spinal Nerves
The Sympathetic Trunk
Instruments
Equipment Used for Endoscopic Procedures
Portals and Trocars
Basic Surgical Instruments for Thoracoscopy
Special Instruments Used for Spinal Thoracoscopic Procedures
Surgical Techniques
General Principles
Anesthesia
Positioning
Operating Room Set Up
Portal Insertion
Inspection of the Pleural Cavity
Exposure of the Rib
Exposure and Removal of the Disc
Vertebrectomy, Vertebral Body Reconstruction and Instrumentation
Wound Closure and Chest Tube Insertion
Postoperative Management and Complications
Pain Control
Chest Tube Management
Complications
Advantages and Disadvantages of VATSS
Advantages (Table 98.3)
Disadvantages (Table 98.4)
Conclusion
99:
Anterior Operative Approaches to the Thoracic Spine
INTRODUCTION
Patient Selection
Surgical Access
Surgical Approach to the Upper Dorsal Spine D1- D3
Steps
Surgical Approach to the Mid Dorsal Spine D4-D7
Steps
Technique of Decompression
Steps
Technique of Stabilization
Steps
Wound Closure
Approach to the Lower Dorsal Spine D10-D12
Steps
Postoperative Care
Complications
A Case Report
New Developments
Conclusions
100:
Transpedicular Decompression for Extradural Spinal Cord Decompression
INTRODUCTION
Historical Background
Material and Methods
Group I: Tuberculous Spondylitis
Group II: Trauma
Group III: Metastasis
Operative Procedure (Fig. 100.5)
Results
Complications
Discussion
Conclusions
SECTION 18: COMPLICATIONS IN SPINAL SURGERY
101:
Complications in Cervical, Thoracic and Lumbar Spinal Surgery
INTRODUCTION
Complications in Cervical Spinal Surgery
Neural Injury
Anterior Surgery
Posterior Surgery
CSF Leak
Recurrent Laryngeal Nerve Palsy
Horner's Syndrome
Bleeding
Complications Related to Bone Grafting and Fusion
Instability
Implant Related Complications
Respiratory Complications
Infection
Complications in Thoracic Spinal Surgery
Neural Injury
Instability
Visceral Structure Damage
Implant Related Complications
Complications in Lumbar Spinal Surgery
Neural Injury
Incidence of Dural Tear
Vascular and Visceral Injuries
Infection
Instability
Complications Related to Fusion
Implant Related Complications
Recurrence of Symptoms
Miscellaneous Complications
Conclusion
References
CERVICAL SPINE
THORACIC SPINE
LUMBAR SPINE
102:
Surgical Treatment of Postoperative Lumbar Infections: A Retrospective Study of 58 Cases. Reflections on the Influence of Instrumentation
INTRODUCTION
Material and Methods
Material
Methods
Results
Results According to the Patients Background (Table 102.5)
1. Population I: Infections
The Cases
The Treatment
2. Population II: Infections
The Cases
Treatment (Table 102.7)
Repeated Revisions for Sepsis
Revisons for Mechanical Reasons
General Complications
Results According to the Localization
Horizontal Spreading Led to Discitis in Nine Cases
Vertical Spread (Three cases) Involves other Problems
Discussion
Conclusion
103:
Failed Back Surgery Syndrome (FBSS)
INTRODUCTION
Proper Selection
Late Presentation
The Surgery
Crucial Operation
Surgeon's Outlook
Common Clinical Problems
Failure to Recognize the Instability
Iatrogenic Instability
Posterolateral Fusion
Disc Space Infection
Nerve Root Damage
Presenting Features
The Criteria
The Unhappy Patient
SECTION 19: SPASTICITY
104:
Treatment of Spasticity
INTRODUCTION
Baclofen
Intrathecal Baclofen in Spasticity
Clinical Preselection
Lumbar Test
Implantation for Chronic Intrathecal Administration
Determination of Effective Daily Dose
Follow-up Monitoring
Complications of Intrathecal Baclofen Administration
Other Uses of Baclofen
105:
Neurosurgical Management of Spasticity
INTRODUCTION
Selection Criteria
I. Detection of Nonprogressive: Nature of the Disorder
II. Detection of Harmful Spasticity
1. Disabling Spasticity
2. Development of Complications of Spasticity
3. Discomfort, Pain and High Energy Consumption
III. Detection of Resistant Spasticity
IV. Detection of Probable Safety and Usefulness of the Procedure
V. Discussion of Goals
Ideal Case
Treatment
Treatment Protocol
Peripheral Neural Blocks
Central Spinal Nonablative Procedure
Spinal Cord Stimulation (Dorsal column stimulation, Posterior column stimulation)
Intrathecal Baclofen
Central Cranial Nonablative Procedures
Neurostimulation of Brain
Peripheral Extracraniospinal Ablative Procedures
Neurotomy (Electrostimulation, selective functional fasciculotomy)
Classification
Peripheral Spinal Ablative Procedures
Rhizotomy (Electrostimulation selective functional posterior rhizotomy-ESSFPR)
Open Surgical Method
a. Lumbosacral
b. Cervicothoracic
c. Sacral
II. Closed Surgical Method
Percutaneous Radiofrequency Posterior Rhizotomy
III. Nonsurgical Method
Chemical Rhizotomy
Microsurgical Drezotomy (MDT)
Central Spinal Ablative Procedure
Longitudinal Myelotomy
Central Cranial Ablative Procedures
Stereotactic Ventrolateral Thalamotomy9,50,61,62
Stereotactic Dentatotomy31,33,40,46,47,89
106:
Tizanidine in Spasticity: Pharmacology and Therapeutic Applications
INTRODUCTION
PHARMACOLOGICAL PROFILE OF TIZANIDINE
I. Muscle Relaxant Activity
Inhibition of Rigidity
Modification of Stretch Reflex Activity
Muscle Relaxant Activity and Sedative Properties
II. Analgesic Activity
III. Psychotropic Activity
IV. Cardiovascular Activity
V. Biochemical Activity
Basis of Muscle Spasm and Mechanism of Action of Tizanidine
Pharmacokinetics
Adverse Reactions
Contraindication and Precautions
Interactions
Preparation and Dosage
Therapeutic Applications
Painful Muscle Spasms
Acute Musculoskeletal Conditions of the Neck
Acute Low Back Pain
Spasticity due to Multiple Sclerosis
Spasticity due to Spinal Cord Injury
Miscellaneous Uses
SECTION 20: PRESSURE SORES/SPECIALIZED PROCEDURES
107:
Pressure Sores
INTRODUCTION
History
Pathology
Presenting Features, Diagnosis and Preliminary Debridement
Complications
Management of Pressure Sores
Surgical Treatment
108:
Use of Spinal Cord for Treatment of Vegetative State after Head Trauma—Dorsal Column Stimulation
INTRODUCTION
Materials and Methods
Results
Discussion
109:
Advances in Electrophrenic Respiration
INTRODUCTION
Phrenic Nerve Dysfunction
Methodology
Components
Application
Basic Requirements
Evaluation of Phrenic Nerve Function
Nerve Anastomosis
Reconditioning of Muscle
Timing of Stimulation After Surgery
SECTION 21: ANESTHESIA/RELIEF OF PAIN/REHABILITATION
110:
Anesthesia for Spinal Surgery
INTRODUCTION
Autoregulation of Spinal Cord Blood Flow (SCBF)
Position of Patient and Anesthesia
General Considerations
Prone Position
Lateral Position
Supine Position
Sitting Position
Principles of Anesthesia
Preoperative Evaluation
Investigations
Premedication
Anaesthesia
Intraoperative Monitoring
Fluid Maintenance
Wake up Test
Postoperative Period
Complications
Anesthetist and Spinal Cord Injury (SCI)
Anesthesia in Acute Phase
Anesthesia in Chronic Phase
Anesthetic Implications for Common Spinal Problems
Myelomeningocele
Down's Syndrome
Syringomyelia and Arnold-Chiari Malformation
Anterior Cervical Fusion
Lumbar Disc Surgery and Internal Decompression for Spinal Stenosis
Posterior Lumbar Interbody Fusion (PLIF) and VSP Pedicle Screws and Plates
Arteriovenous Malformation
Anterior Approaches to the Dorsal Spine
Transoral Approach to Anterior, Craniovertebral Junction
Tumors of Spine and the Spinal Cord
Kyphoscoliosis
Rheumatoid Arthritis
111:
Relief of Postoperative Pain in Spinal Surgery
INTRODUCTION
Tissue Injury and Pain
Adverse Effects of Pain
Modalities of Pain Relief
A. Action on Peripheral Nerves
Methods Acting at Periphery
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
Local Anesthetic Techniques
Methods Acting at Spinal Cord Level
Epidural Opioids
Complications
Intrathecal Opioids
Combined Opioids and Local Anesthetics
Systemic Analgesics
Complications of PCA
Assessment of Pain
Visual Analogue Scale (VAS)
Simple Questionnaire (Five-Point Global Scale)
Objective Measurement of Relief
Patient Demand Analgesia
Recent Concepts in Postoperative Analgesia
Multimodel Therapy or Balanced analgesia21,39
Preemptive Analgesia39
112:
Rehabilitation of Spinal Cord Injuries
REHABILITATION OF THE PARAPLEGICS
Introduction
Incidence of Paraplegia
The Rehabilitation
Conservative Management
Surgical Intervention
The Rehabilitation
Short-term Goals
Long-term Goals
Clinical Aspects
T1-T5 Lesions
T6 – T12 Lesions
Physical Therapy
Occupational Therapy
REHABILITATION OF TETRAPLEGICS
Introduction
Lesions at C1 to C4
Lesions at C5 to C6
Lesions at C7
At C8
PHYSIOTHERAPY MANAGEMENT IN CERVICAL LESIONS
Acute phase
Respiratory Complications
Physical Therapists Respiratory Therapists Make Use of
Maintenance of Mobility and Prevention of Contracture and Edema by
Reduction of Spasticity
Prevention of other Complications
Bedsores
Preventive Methods
Treatment of Bedsores
Urinary Complications
Achieving Maximum Possible Level of Motor Function
Physical Therapy in Chronic Stage
Conclusions
INDEX
TOC
Index
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